Over 4 lakh TB cases ‘missing’ from radar: Govt report

Maitri Porecha New Delhi | Updated on June 24, 2020 Published on June 24, 2020

Missing patients have remained the bone of contention for the National TB Elimination Programme. Representative image   -  Reuters

Up to 79,144 TB deaths were officially reported in 2019, much lower than the estimated 4.4 lakh

Up to four lakh tuberculosis (TB) patients slipped through the cracks in 2019, the annual ‘India TB report 2020’, compiled by the Ministry of Health and Family Welfare (MoHFW), reveals. The MoHFW constantly seeks to fill the gap by identifying missing patients, as India has set a target to eliminate TB by 2025.

In 2019, 24.04 lakh patients were notified or registered in the records of the MoHFW, an increase of 11 per cent over the previous year. Up to 6.7 lakh patients were from the private healthcare sector. India estimates that there were at least 26.9 lakh TB patients across the country in 2019, and up to 2.9 lakh patients were ‘missing’, or failed to be picked up.

In India, the cascade of care declines — as of 24.04 lakh patients, only 22.7 lakh (94.4 per cent) patients were started on standard first line treatment, another 1.3 lakh (up to 6 per cent) were lost to follow-up. Those failed to be picked up and those lost to follow-up together constitute 4.22 lakh missing TB cases.

India has set a target to eliminate TB by 2025. The plan was announced by Prime Minister Narendra Modi, following which a National Strategic Plan (NSP) was charted out in 2017 for implementing the target.

Uttar Pradesh (20 per cent), Maharashtra (9 per cent), Madhya Pradesh (8 per cent), Rajasthan (7 per cent) and Bihar (7 per cent) represent half the total TB burden in India, the report observes. Sanjeeva Kumar, Additional Secretary, MoHFW, said the NSP envisions a TB-free India with zero deaths and zero TB disease. In 2019, 159 persons for every one lakh persons was detected with TB, which is among the highest incidence rates in the world. While India talks of eliminating TB, it is yet not detecting all patients with the disease.

Bone of contention

Missing patients have remained the bone of contention for the National TB Elimination Programme. The report states: “The programme missed 10 per cent of the estimated drug sensitive cases and 50 per cent drug-resistant cases. A major hindrance in detection of TB patients is poorly established specimen collection and suboptimal transportation systems, which adversely affect the TB programme.”

The cascade of care further declines as treatment outcomes in at least 20 per cent of the patients are poor. As of 2018, the report states, 21.02 lakh patients were notified, and from that cohort treatment was initiated in 20.2 lakh (up to 96 per cent) but was successfully completed in only 16.79 lakh (80 per cent).

Under-reporting of TB deaths is a major issue. Up to 79,144 persons (4 per cent) of all registered patients died, which is way lesser than the 4.49 lakh estimated deaths believed to have occurred in 2019. The Centre does not know what happened to another 86,206 patients because they were not successfully followed up. In close to another 1 per cent, up to 14,318 patients, the treatment failed. Death rate and loss to follow-up rate have shown no improvement over last year, the report states.

Of all the cases registered, up to 1,51,286 were identified as children. One in every two children with TB is never picked up, as the number of childhood TB cases reported in India is only 44 per cent of an estimated 3,42,000, which should ideally be picked up.

Access to treatment

Also, access to treatment in patients having multi drug resistant (MDR) and rifampicin-resistant (RR) TB cases is poor. In 2019, 66,255 patients were MDR or RR TB, of which 85 per cent (56,569) were put on treatment. Access to high-end drugs was limited with 5513 patients receiving bedaquiline and only 264 patients receiving delamanid.

“Robust efforts are needed to sustain and improve on the gains made to date and to address persistent challenges that have led to uneven progress in the fight against tuberculosis, including from the complex challenges created by the rise of drug-resistant forms of TB,” said Vikas Sheel, Joint Secretary, MoHFW.

At least 3,882 persons were found in whom most TB drugs do not work. They had reached the extensive drug resistance (XDR) phase. Amongst those who transgress to XDR TB, only 37 per cent are treated successfully, while another 37 per cent die and an additional 14 per cent are lost to follow up, the report notes.

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Published on June 24, 2020
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